I just finished 6 weeks of incontinence therapy my urologist thought I might benefit from. My da Vinci radical robotic prostatectomy surgery was in 12/2008. For the past 9 months or so, I've made no progress toward 100% leak elimination. I've been wearing a men's brief with a built in pad for those times I would "leak" inadvertently. (I've posted on these briefs in the past.)
He recommended this incontinence therapy his office sponsors (outside vendor comes in) saying his patients who were like me, nearly continent, but not quite there, have benefited from it. The vendor is Mobile Diagnostic Solutions out of Orlando, FL. They have therapists that cover this entire wide section of central Florida. I can't speak for how available this type of therapy is outside this area. There are likely similar programs elsewhere.
The therapy was originally geared toward women and the "information packet" discusses many exercises that are women only (vaginal weights, etc.), but the therapy has been adapted for men. I will explain in a minute.
Ok, basically this is a glorified KEGEL exercise. Yes, I know, I know, Kegels are the worse. Do them over and over and for what? Not much improvement. But this therapy is Kegels on steroids.
The therapy involves bio-feedback, TENS machine exercise and acupuncture, plus guided exercise at home with some void and leak record keeping. After 6 weeks, my weekly "leak" count went from 6-8 to zero. For the past 3 weekends, I've been wearing men's boxer underwear (preferred here in the FL heat) all weekend, and today I wore boxer's on my graduation day and all day at work with no leaks. I consider this a success.
The women's therapy involves a squeeze probe that is inserted into the vagina and a Kegel is done. The probe and computer software measure the strength of the compression on a graph and the patient is told to hold for 10 seconds while the graph shows the level of pressure. The goal is to be able to hold the squeeze with no drop off in intensity for the time period, then a 10 second rest, and another cycle. 3 cycles are required to "pass".
The men's therapy uses the rectum to measure the Kegel muscle strength. This might make some men a bit squeamish, but after what we've been through, no big deal. No pain, no discomfort.
There is also an electrode that connects to the abdomen to ensure that the stomach muscles are NOT involved in the Kegel. They only want to pelvic floor involved.
TENS MACHINE EXERCISE
After the probe, the therapist sticks a couple of electrodes across the back of the leg and across the pelvic floor. Some low voltage, low current is applied in a fashion to cause just the Kegel muscle to tense and relax 10 seconds on, 10 seconds off. This cycle is repeated for about 15 minutes. This trains the Kegels to contract much more than simple Kegels do.
While this is going on...
The therapist also applies an electrode on the bottom of the right foot and sticks a painless acupuncture needle into the ankle. A small electronic stimulator is applied to the electrode and needle and voltage is applied in a pulsing action. Again, painless. The info book calls this: "Percutaneous Tibial Nerve Stimulation".
This entire process takes no more than 30 minutes. I would stop by the office on my way from work or my way home after work.
Ok, This is the suck part. Kegels. The therapist assigned certain Kegel instructions each week. The first few weeks were just 10 squeezes, holding for 10 seconds, each with 10 second relaxation between them, 3x per day. When I finished I was up two 15 squeezes, 15 seconds long, with 10 second relax, still 3x per day. Plus, assigned another kind of quick flick Kegel, squeeze quickly then release. I ended with 15 quick flicks in a row, doing this 5 times a day.
Also assigned was a daily diary of recording day and night time voids, plus any instances of a "leak". These were recorded by the therapist in the patient log to look for progress, etc.
Kegels on steroids. But it worked for me.
One final note: I found a fantastic Android phone ap that helps with the Kegel count/hold/relax for those who own an Android phone. I'm sure the iPhone has similar software.
Search the Android Market Place for "kegel muscle exerciser pro" by AndroidPublisher. The pro is $0.99. The free version serves ads. I tried the free and felt it would be worth the money to kill the ads.
That's it. I hope this helps someone.